Journal of Ophthalmic & Vision Research最新文献

Purpose: To evaluate the impact of inadvertent intraoperative microperforation of the trabeculo-Descemet's membrane (TDM) on postoperative outcomes in cases with cataract and either primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEXG) during combined phacoemulsification and deep sclerectomy (PDS).

Methods: In this prospective case-control study, 73 eyes of 73 patients with cataract and POAG/PEXG who underwent PDS were enrolled. Patients were divided into two groups based on the presence or absence of inadvertent intraoperative TDM microperforation. The primary outcome measures included intraocular pressure (IOP), number of antiglaucoma drugs, and assessment of adverse effects during a six-month follow-up period.

Results: Significant decreases in IOP were observed at all follow-up time points (day 7, month 1, and month 6) in both groups compared to baseline (P $<$ 0.001). No significant differences in IOP were found between the groups at any time point, except on day 7, while the perforation group exhibited a significantly lower IOP compared to the non-perforation group (11.84 $\pm$ 4.78 vs 14.03 $\pm$ 2.50 mmHg, P = 0.017). At month 6, the mean number of antiglaucoma drugs was 0.19 $\pm$ 0.46 in the perforation group and 0.06 $\pm$ 0.23 in the non-perforation group, suggesting a significant reduction in both groups compared to baseline (P $<$ 0.001) with no statistically significant difference between the two groups (P = 0.124). Hypotony was observed in 3 (8.1%) eyes with perforation, but it resolved without persistent complications in subsequent follow-ups.

Conclusion: Inadvertent TDM microperforation during PDS for POAG or PEXG did not impact IOP outcomes compared to non-perforated cases over a six-month period, nor did it increase the incidence of complications.

Purpose: To report a case of a patient diagnosed with arteritic anterior ischemic optic neuropathy, who was later diagnosed with a severe form of Takayasu arteritis (TA).

Case report: A 34-year-old lady presented with a sudden, painful loss of vision in the left eye for four months associated with headache and jaw claudication. Ocular examination revealed features suggestive of arteritic anterior ischemic optic neuropathy and microaneurysms scattered throughout the fundus in both eyes, consistent with Takayasu retinopathy. General examination and investigations, including CT aortogram, confirmed the diagnosis of TA. Despite being put on maximal immunosuppression, she developed severe systemic manifestations within the next three months and passed away due to the illness.

Conclusion: AION as a presenting feature in the setting of TA is uncommon, and its occurrence may indicate a progressive course and poor systemic outcomes.

Purpose: To investigate the incidence and risk factors of intraoperative complications during phacoemulsification surgery performed by ophthalmology residents at an academic training center.

Methods: This comparative case series included 1121 eyes of 821 patients that underwent phacoemulsification cataract surgery by ophthalmology residents from March 2020 to March 2021. Patients' medical records were reviewed for demographics, systemic and ophthalmic comorbidities, biometric data, surgical details, anesthesia type, residents' training year, and the occurrence of any intraoperative complications. Multivariate models were used to identify potential risk factors for intraoperative complications.

Results: Intraoperative complications were observed in 63 eyes (5.6%). From the most to the least frequent, they included posterior capsular rupture with vitreous loss in 29 eyes (2.6%), anterior capsular tear in 21 eyes (1.9%), nucleus drop in 8 eyes (0.7%), zonular dehiscence in 3 eyes (0.3%), and posterior capsular rupture without vitreous loss in 2 eyes (0.2%). On univariate analysis, mature or brunescent cataracts (OR = 3.096, P = 0.031), residents' training year (OR = 2.238, P = 0.017), and pseudoexfoliation (OR = 2.247, P = 0.049) were associated with vitreous loss. Multivariate data analysis indicated that mature or brunescent cataracts (OR = 4.046, P = 0.009) and residents' training year (OR = 3.238, P = 0.005) were independent risk factors for vitreous loss.

Conclusion: We observed a higher rate of intraoperative complications in eyes with mature or brunescent cataracts or in procedures performed by less experienced residents. Proper case selection and direct attending supervision are crucial in preventing intraoperative complications at ophthalmology training centers.

Purpose: Human vision is subnormal in an aquatic environment, and studies have used different methods to measure visual functions with water-induced blur (WIB). In this study, we compared vernier acuity measured using three different WIB simulation methods.

Methods: Sixty young adults (20 in each group) with best-corrected visual acuity of $\ge$ 6/6 participated in the study. Three different methods, one for each study group, were used to simulate WIB in order to measure the vernier acuity. The methods comprised M1: a glass tank filled with water containing a wave motor to produce waves, M2: a sprinkler with uncontrolled water splash against the glass, and M3: a sprinkler with controlled water splash against the glass. For each of the three methods, vernier acuity was measured binocularly (three trials of 50 presentations each) both at baseline (without simulated WIB) in the absence of WIB and under simulated WIB. This was conducted using FrACT presented on the Display++ monitor at a distance of 2 meters from the participant. The vernier target consisted of two vertical lines (1 x 15 arcmin) with a vertical separation of 0.5 arcmin.

Results: The mean baseline vernier acuity (arcsec) was found to be similar (F^{[2, 57]} = 0.20, P = 0.82) among all three groups (M1: 13.28 $\pm$ 5.84, M2: 14.44 $\pm$ 6.34, M3: 14.05 $\pm$ 3.28). Vernier acuity with simulated WIB was least degraded with M1 (19.84 $\pm$ 8.40) and more degraded with M2 (288.74 $\pm$ 56.61), followed by M3 (49.14 $\pm$ 20.13). One-way ANOVA revealed a significant difference among the three methods (F [2, 57] = 354.72, P $<$ 0.001).

Conclusion: Our results suggest that the impact of simulated WIB on vernier acuity is not comparable due to differences in the strength of blur and the varied spatial and temporal properties of different simulated WIB methods. This emphasizes the need to develop a blur metric specific to WIB to objectively quantify its effect on different visual functions.

Purpose: Vascular changes along with loss of the neural rim at the optic nerve head (ONH) are established hallmarks of glaucomatous optic neuropathy. The current study investigates changes in the position of major retinal vessels outside the ONH in eyes with definite or suspected glaucoma and reports its clinical associations.

Methods: This retrospective case-control study was conducted on a dataset of 2390 patients with definite or suspected glaucoma and serial photographic documentation from 2015 to 2022. Images were overlaid chronologically and examined for vascular displacement (VD) outside the margin of the ONH up to one disc diameter using the built-in fundus camera software; in the case of VD detection, the change was verified using MATLAB software. The amount of VD was measured in pixels and expressed in a unitless arbitrary ratio derived from the amount of VD in pixels divided by the largest optic disc diameter in pixels. During the study period, a small number of eyes showed evidence of VD, which made up the case group; eyes without evidence of VD from the same dataset were chosen as controls.

Results: A total of 23 eyes demonstrated VD, and 60 eyes with no evidence of VD were selected as controls. The mean amount of VD was 0.15 $\pm$ 0.01 in case eyes compared to 0.01 $\pm$ 0.01 in control eyes (P $<$ 0.001). Definite glaucomatous damage was observed in 20 (87%) eyes in the case group compared to 35 (58.3%) eyes in the control group (P = 0.014). The best-corrected visual acuity in eyes with VD, both at baseline and at the final visit, was significantly worse than in controls (P = 0.018 and P = 0.032, respectively). Eyes with VD had greater cupping both at baseline (P = 0.025) and at the final examination (P = 0.04). During the study period, 16 (69.6%) eyes with VD and 12 (20%) control eyes required glaucoma surgery (P = 0.001). Patients with VD also showed a statistical trend toward being younger (mean age, 54.5 $\pm$ 16.5 vs 61.3 $\pm$ 15.5 years, P = 0.088).

Conclusion: VD outside the ONH may occur in eyes with glaucoma and is associated with factors reflecting more significant glaucomatous damage. Eyes with VD outside the ONH have lower visual acuity, greater cupping, and require glaucoma surgery more often, indicating more significant glaucoma severity or progression.

Purpose: This study aimed to report the efficiency and safety of using intensity-modulated radiation therapy (IMRT) in treating diffuse choroidal hemangioma (DCH) in patients with Sturge-Weber syndrome (SWS).

Methods: IMRT planning was carried out for each case after patient fixation, CT simulation, and target delineation. The purpose of treatment planning was to deliver the prescribed dose of 20 Gy to at least 95% of the planning target volume (PTV). The primary follow-up goal was to evaluate the efficacy and safety of IMRT as an alternative to traditional 3D conformal radiotherapy methods. The case series involved patients with DCH and varying degrees of vision impairment who underwent IMRT.

Results: Five patients, comprising two men and three women, with an average age of 14.4 $\pm$ 3.78 years, were included in this study. These patients were followed up for an average duration of 14.4 $\pm$ 6.84 months. All patients exhibited notable reduction in subretinal fluid, significant tumor regression, and minimal side effects. Visual acuity improved in patients with pre-IMRT vision of hand motion or better.

Conclusion: The findings suggest that IMRT is a promising, low-complication treatment option for managing DCH in SWS patients, warranting further research and potential integration into clinical practice.

Giant cell arteritis (GCA) is the most common vasculitis of large and medium vessels affecting adults over the age of 50. Due to its acute ischemic damage through a systemic inflammatory process, GCA is a medical emergency with the risk of permanent vision loss. Therefore, early intervention is critical. Patients often present with well-documented systemic manifestations such as jaw claudication, headache, scalp tenderness, and fatigue. These patients are usually subject to blood tests for inflammatory markers and temporal artery biopsy. However, clinical manifestations vary considerably and may masquerade as neuro-ophthalmic manifestations that are not pathognomonic of GCA. We conducted a review to discuss documented neuro-ophthalmic manifestations and provide insight into the rare presentations to help avoid pitfalls in its diagnosis. Findings from the included articles were sorted into afferent and efferent neuro-ophthalmic manifestations. According to our literature review, the main afferent manifestations documented are ischemic optic neuropathy, retinal artery occlusion, choroidal infarction, ocular ischemic syndrome, orbital inflammatory syndrome, and strokes causing visual field loss. The efferent manifestations include cranial neuropathy (3 ${}^{\text{rd}}$ , 4 ${}^{\text{th}}$ , and 6 ${}^{\text{th}}$ ), extraocular muscle ischemia, and internuclear ophthalmoplegia. Other rare causes are tonic pupil from ciliary ganglion involvement, uveitis, and encephalopathy. If GCA is suspected, in addition to inquiring about systemic symptoms and doing a complete neuro-ophthalmic exam, these patients should be sent for inflammatory serological markers, as well as temporal artery biopsy (TAB). If clinical suspicion remains high, high-dose steroids should be started immediately.

This review article explores the etiology of oculomotor palsies-including third, fourth, and sixth cranial nerve palsies-and addresses the application of botulinum toxin type A (BoNT-A) in the management of these conditions, along with its associated complications and side effects. The objective is to assess BoNT-A's potential efficacy and its role across various types of nerve palsies. A comprehensive analysis of relevant studies reveals that BoNT-A holds promise as a therapeutic option in managing these conditions. BoNT-A injection into the lateral rectus muscle proves to be an effective treatment for addressing post-traumatic third nerve palsy. This is achieved by providing symptom relief and diminishing the necessity for subsequent surgical interventions. In the context of fourth nerve palsy, BoNT-A injection into the inferior oblique or inferior rectus muscles presents potential benefits but is accompanied by certain limitations. Additionally, previous studies have shown that BoNT-A injection into the antagonist medial rectus muscle for treatment of sixth nerve palsy results in favorable outcomes, such as contributing to functional improvement. The literature highlights the importance of timing, dosage, and grade of muscle dysfunction when administering BoNT-A injections. BoNT-A injection is an effective option to manage different types of cranial nerve palsies and improve binocular function. Furthermore, it plays an integral role in preventing antagonist muscle contracture and, hence, the need for future surgical intervention.

Purpose: To assess the performance of a hybrid Transformer-based convolutional neural network (CNN) model for automated detection of keratoconus in stand-alone Scheimpflug-based dynamic corneal deformation videos (DCDVs).

Methods: We used transfer learning for feature extraction from DCDVs. These feature maps were augmented by self-attention to model long-range dependencies before classification to identify keratoconus directly. Model performance was evaluated by objective accuracy metrics based on DCDVs from two independent cohorts with 275 and 546 subjects.

Results: The model's sensitivity and specificity in detecting keratoconus were 93% and 84%, respectively. The AUC of the keratoconus probability score based on the external validation database was 0.97.

Conclusion: The hybrid Transformer-based model was highly sensitive and specific in discriminating normal from keratoconic eyes using DCDV(s) at levels that may prove useful in clinical practice.

Retinal degenerative diseases (RDD), which impair photoreceptors, the retinal pigment epithelium (RPE), and associated retinal cells, result in severe vision loss. For patients with advanced RDD, tissue replacement therapies, such as transplantation, offer potential pathways to visual rehabilitation. While fetal retinal transplantation has shown some promise in preclinical and clinical studies, human pluripotent stem cell (hPSC)-derived retinal organoids (ROs) present a promising alternative. ROs are three-dimensional tissues that replicate key aspects of retinal development, making them viable candidates for transplantation. However, the path toward clinical application faces two primary challenges: achieving Good Manufacturing Practice (GMP)-compliant production and overcoming technical difficulties associated with safe transplantation. Current RO production protocols are often limited by variability in tissue morphology, yield, and reproducibility, while transplantation efforts are hindered by rosette formation and mechanical damage to the subretinal space. Recent innovations, including automated bioreactor systems and optimized surgical techniques, offer potential solutions. Further advances in understanding and preventing rosette formation are essential to improve transplantation outcomes. Continued research and technological development are necessary to unlock the full potential of ROs for visual rehabilitation in patients with retinal degeneration.